Veterans" Hosp. 757,

Waukeshe, Wisconsin,
April 18, 1922.

Dre WeP, Lorena, Director —
Wiseonsin Peychiatric Institute,
Mendgetea, Wisconsin.

My dear Dr. Lorena:

tT have your personel letter of April l4ths, in which you
have given your impressions concerning certain conditions at this
hospital end have indicated lines of procedure by which these con-
ditions may be chenged for the better. Please accept my thanks
for your kindly interest end do not think for an instant taat I
feel you ere "butting in'.s On the contrary, I feel that if we are
to adivence and improve we must have unbiaged eriticiagm of this kind -
from persons who, like yourself, ean speak with authority becauge
of the knowledge and experience they heve had in thie apeciel line
of work,

Tt am especially ocleased to have you eriticise our laboratory.

 
I am enclosing & copy of on article on Blood Resistence which
Levine wrote and which has been accepted for publication, Iz you
eare to criticise this I would be pleased to have you do go,

There is being carried on in the laboratory at the present time
some further research in blood chemistry and some studies in Basal
Metaboliam are being made, In addition, Levine i@ making ® urinary
survey, Which I do not think mich of and he is reviewing five
hundred histories in order to tabulate certain organic feetors in
Our Gases, This latter wae an ides of his own. I @o not think
he ¢an me@ke anything of it end in any event this ground has boen
fa well covered by several articles written by three of out

officers,

 

 

A to dia
a. @ ipere 1 ;

pline at the hospital, it eannot be denied thet we
ax in ihe privileges we aliow petients, Within the .
hog wite LL We, howe vor, ao heve good order, considering tae @¢Llase or. ‘
patients treated, Within the past month there has not been & oaae. \
<i Gyunkenness brougat to my attention, No doubt, some of the men

ave boon drinking, but they have not been under the influence of
Liquor. Algo, eyery ebsenee from this heapitel is covered by a
DEBS. Jar eoee in this respect are, of course, quite often

broken end we attempt to meet this situation by mild disciplinary
Measures ae by threats of whet might happen to the sompencation Hy
and vo sh hig training of @ men who conducts himself otherwise than
in accorda with our rules, You, of course, appreciste that we
have a aeaee of petients here who in the army Were A, WyOule Fe-
peatedly in spite of rether severe diacipline and punishment, The
delinquencies of these men are a part of their disorder and it is 4
moot question whether the situation is best met by severity or by
persuesive sethods such ac we use, tin hendlinge this problem we

have to remember thet arny methods, although they may be good,

carmot be applied where the authority which the army -hes 18 ie@ekings

 
«Sow

In other words we have a different situation te mest and some
modification of methods is necessary, I heve often disoussed
this matter with Dr, Heldt and other members of the staff end we
have evolved a method whieh, 411 things being considered, seems to
as to give the best resulte. I know thet in carrying out dieei-
plineary measures wo sometimes make mistakes and ere more Liberal
then We ought to be and it ie possible that our general policy iz
too liberal, With thie idea in mind we intend to tighten up -
gradually. : |

That a good many of the patients in the hospital would be just
as Well off outside cannot be denied, You have sensed the |
diffienity in your reference to the pressure whieh brings this
situation about. It i# discouraging to thoroughly study 4 case,
have the steff pass upon it end diecherge him and then find that
in about two weeks he has through pressure of some kind or snother
hed himeelf admitted to a howpitel erain, Thies happens elsewhere
88 Well as here end { heve heerd men from generel hospitele, ea.
well as disinterested. observers, sey thet we are no worse off in
this sitespéck than other institutions ere, This, of course, does
not exeuse us for not elearing out those who should not be here 3
but I am going to recite an incident which illustrates the difficalty
of whieh you ere already avwere; Be

‘Rast spring Dr, Heldt was away from the hospital for about two
months, We hed @ number of difficult. cases,no longer in need of _
treatment, which we were eraduslly discharging with ea little
friction es possible, Dr, Benton, whe took charge of the staff, |
wes of the opinion that these discherges should be brought about
more rapidly, He waa given cherge of the staff and I allowed him
to try his scheme out, Benton was a good mam, He hae a thorough
wunderstending of psychoneureséas and got splendid reaults in the
management of his own cages, He was aise well liked by his
patients, but when thia diseharging began he became quite unpopular,
Some psychopaths among the crowd were peorsueded to make affidavits |
in which we were sceused of being severe in discipline, illiberal
im passes, aceusing patients of not being 111 and the like. we
eould heave worked out. this situation elright if Berrett head not ia ides
taken @ hand, ‘They took the matter up with Barrett. He came down
here and,aithough I elearly showed to him the paychopathic nature of
some of the complaining patients and gave him to understand thet T-
oonsidered Benton @ highly eapeable officer, insisted that Benton .
should be transferred, In fact, he wanted me to wire while he was
in the office here talking over the situations I 414 not fo this,
but in order to avoid a row the situstion was explained to the
Surgeon General and Benton's transfer was recommended,  Berrett
knew of this and because my recommendation was not acted upon
within e@ very short time, he wired Lenroot saking him to have the
Senate Committee then investigeting hegpitals make a special in-~
vestigation of this places, the Surgeon Gonerfl thereupon ~oved
Benton and Barrett called off the investigation,

I am not reciting this ineldent in eny critieiam of Berrett,
He wentea to do the right thing, but unfortunately he seems to heve
assumed that everything must be wrong ond with this assumption he
hes acted upon complaints witheut judiciously weighing the evidence, —

 
| r | fae a

‘Barret hes not yet communicated with me regarding your letter to

him noy hes he seted upon the suggestion f meade to him, after eon- —

sulting with you, that he appoint @ disinterested committee to 4
 ‘Gavestigate complaints at the hospital, | ee ee

In gonelusion, I wish agein to thank you for your criticiem
and to announce thet when I come to see you I went you to give me
your frenk opinion and suggestions, ee |

- With kindest regeras, I em

Very truly yours,

_ Lawrence Kolb,
Surgeon in Cherges